secondary amenorrhea

Question 1

secondary amenorrhea diagnosis

Answer 1

if menses have been absent
for over 3 months
or there is oligomenorrhea resulting in
less than 9 cycles a year

Question 2

the most common causes of secondary amenorrhea include

Answer 2

*Pregnancy
*polycystic ovary syndrome
*hypothalamic amenorrhea
*hyperprolactinemia
*ovarian failure

Question 3

approach for secondary amenorrhea

Answer 3

1) Pregnancy test to R\O pregnancy
2)Assess history: change in weight, diet , exercize , or chronic disease that may affect the hypothalamus
3) contraception use
* Androgenic drugs
* Anti-psychotic(risperidone-increases prolactin)
4)Ask about headache, vision problems , galactorrhea ? (prolactinoma)
5)Ask about hot flashes, vaginal dryness, sleep problems and decreased libido (premenapause )
6)Ask about hirsutism, irregular cycle, acne , infertility?(PCOS)
7) Ask about obstetrical complications : massive bleeding
uterine infection, aggressive dilatation and curettage(asherman syndrome)

Question 4

lab investigation if not pregnant

Answer 4

*Serum prolactin to R\O
hyperprolactinemia(Next
step
TSH to R\O thyroid disease

FSH : If low : hypothalamus or
pituitary disease.
If high : ovarian failure
If normal but low estrogen :
stress

Androgen hormone
Testosterone level and
DHEA-S
(dehydroepiandrosterone
sulfate )

** iff all normal look for
Asherman syndrome: